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COVID-19-related mental health issues could have long-term effects on healthcare workers

Essential workers have the highest rates of adverse mental health outcomes compared to all other employment groups surveyed by the CDC.

Mallory Hackett, Associate Editor

Burnout among healthcare workers has been an issue even before the pandemic, but the physical and mental toll of working on the front lines could have lasting mental health implications for months and years to come, according to Dr. Robert Cuyler, the chief clinical officer for Freespira, a prescription digital therapeutic for panic attacks and post-traumatic stress disorder.

"Healthcare folks are so focused on caring for their patients that it's sometimes after the disaster that you learn about the aftermath," he told Healthcare Finance News.

As a Louisiana native, Cuyler compared the possible fallout of the pandemic to the months following Hurricane Katrina. He recalled that the mental health consequences of Katrina didn't manifest for some people until months after the event.

"People can be hyper-focused on their daily function and their daily duty and they make their way through it," he said. "It's only afterward that the real extent of the exhaustion, impairment, depression, et cetera really begins to creep in."

Freespira makes an FDA-cleared digital therapeutic to reduce or eliminate symptoms of panic attacks, panic disorder and post-traumatic stress disorder in 28 days.

Highmark, a Blue Cross Blue Shield affiliated organization, announced on February 3 that it is expanding access to Freespira to members in Pennsylvania, Delaware and West Virginia. The expansion of the partnership will include the addition of remote coaching on the use of the Freespira device for members not connected to a trained behavioral health professional, Highmark said.


Beyond the anxiety, stress, depression and loneliness that many healthcare workers have reported experiencing during the pandemic, Cuyler is worried about the risk of healthcare workers developing PTSD related to COVID-19.

Not only are frontline healthcare workers experiencing the sickness, death and devastation of the pandemic on a daily basis – and in some cases doing so with limited staffing and resources – but they are also repeatedly putting themselves at risk for infection.

"We've got this kind of double whammy that goes on with the combination of this exterior traumatic exposure as well as all of the reasons that people are fearful of bodily symptoms," Cuyler said.

Already, the traumatic stress of the pandemic is being researched in healthcare workers.

Essential workers had the highest reported rates of adverse mental health outcomes compared to all other employment groups surveyed by the Centers for Disease Control and Prevention. More than 38% of essential workers reported having a COVID-19-related trauma- and stressor-related disorder. Comparatively, about 25% of nonessential workers reported the same.

Specifically, among healthcare workers, the prevalence of trauma-related symptoms is as high as 35%, according to a report from Frontiers in Psychology. Symptoms were particularly common in women, nurses, frontline workers and workers who experienced physical symptoms of COVID-19.


Cuyler's company, Freespira, offers a potential treatment route for those on the frontlines experiencing PTSD and panic attacks.

Freespira is based on a body of research that shows a link between PTSD and respiratory dysfunction.

"Not only when people are panicky, but even just in their ordinary life, people have very irregular breathing. They sigh, they yawn, they hold their breath, they breathe in what we call 'chronic hyperventilation,'" Cuyler said. "These researchers really posed an interesting question: If you can teach people how to normalize their respiration, would it make a difference?"

Using the Freespira sensor and the accompanying app, patients train their breathing to lessen the symptoms associated with panic attacks and PTSD.

The treatment plan is 28 days long and involves two 17-minute sessions a day where the user is guided through breathing techniques while adjusting their inhales and exhales to keep their exhaled CO2 in the normal zone.

For patients that completed the program, 68% were in remission one-year post-treatment and 91% had significant symptom reduction as long as one year after treatment, according to a study that evaluated Freespira at Alleghany Health Network in Pittsburgh.

"What people do is they learn to spot when their breathing becomes irregular, and they learn this paced breathing technique that they can deploy when they're feeling stressed," Cuyler said.

The study also looked at healthcare cost savings after Freespira was used among Highmark Health's members and found a 35% reduction in any-reason medical costs, a 68% decrease in pharmaceutical costs and a 65% reduction in emergency department costs for the year after treatment.

Cuyler also pointed out that skill-building interventions may be a way to break down the mental health stigma among healthcare workers that keeps many from seeking help.

Studies have shown healthcare personnel, from medical students all the way to physicians, oftentimes don't seek mental health interventions over fears about licensing and hospital credentialing, or fear of being seen as weak and as an embarrassment by their peers.

If anything, the pandemic has accelerated the breaking down of stigmas, thanks to the growing prevalence of telehealth and digital mental health services, according to Cuyler.

"What we've seen that has been a really good trend is we're seeing a real de-stigmatization of accessing mental health services," he said. "And it's increasingly just become [apparent that] we need to learn how to take care of ourselves."

Twitter: @HackettMallory
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This special collection, which will be updated throughout the month, looks at what's being done to ease the burden on providers impacted by COVID-19.